Do You Think You Smell? Olfactory Reference Syndrome

Well, if we assume for a moment that you actually don’t smell or emit some sort of stinky odor, you’re like most people. In this modern world where many don’t think twice about showering each and every day, our bodies often have little chance to work up any kind of odor.

However, if you’re amongst a small group of people who think they smell even when they don’t, then you might be suffering from Olfactory Reference Syndrome. Olfactory Reference Syndrome is a “new” syndrome coined by researchers who’ve discovered that amongst people who think they smell bad — even when they don’t — suicidal thinking and behavior is rampant.

And it’s no wonder — if you think you smell bad and others are noticing the bad smell, and no amount of bathing helps (because the smell is all in the person’s head — it doesn’t actually exist), you might be driven to the edge of hopelessness. Olfactory reference syndrome is thought to be a specific sub-type or related to obsessive-compulsive disorders by some researchers.

The researchers presented their findings at the annual meeting of the American Psychiatric Association this past week.

[The researchers] assessed 20 patients with olfactory reference syndrome seen at Butler Hospital, also in Providence, where Phillips worked at the time, in order to further describe some of its clinical characteristics.

They found that these patients spent three to eight hours a day preoccupied with their concerns that they smelled bad.

Most were convinced that their belief about the odor was real, even though no one else agreed with them or could detect it (85%).

More than three-quarters (77%) thought others took special notice of them.

Where do people think their bad smells are coming from? The researchers discovered that most of the 20 patients their assessed with this syndrome thought that bad smell was coming from their mouth, “followed by the armpits, genitalia, the anus, their feet and their skin. The groin, hands, head, and scalp were other commonly perceived sources of the smell.”

The article also notes, “The vast majority (75%) thought they had bad breath, while 65% incorrectly believed that their sweat smelled bad.”

What do these people do to try and cope with their belief that they smell bad? Not surprisingly, they try and make themselves smell better:

In order to mask their perceived odors, patients most often doused themselves in perfume (90%). Phillips said “some even drank perfume to improve their breath.”

About 70% showered several times a day to rid themselves of the imaginary stench. Others constantly chewed gum (60%) or ate mints (50%). About a quarter reported changing their clothes multiple times a day.

“Some of these patients would use an entire bar of soap in one shower,” Phillips said. “Some are constantly seeking reassurance” that they don’t smell — asking those around them if they’re catching a whiff of anything unusual.

These patients had a significant amount of co-occurring conditions, some of which are potentially serious comorbidities, Phillips said. For instance, 74% at some point had avoided social situations entirely.

Also concerning was the fact that 68% had thoughts about suicide, while 32% had attempted taking their lives at some point.

Just over half (53%) had had psychiatric hospitalizations, and 40% reported being housebound for at least a week at a time because of their perceived odor problems.

Because olfactory reference syndrome is so rare, research into effective treatments for this obsessive disorder are few and far between. EMDR, Abilify, Solian (amisulpride) and SSRIs (selective serotonin reuptake inhibitors — a commonly prescribed type of antidepressant) have all been researched and shown various effectiveness with olfactory reference syndrome.

Don’t worry — this syndrome won’t make it into the DSM-5 as a diagnosable mental disorder, but may be in the “conditions requiring more research” appendix.

Last reviewed: By John M. Grohol, Psy.D. on 27 May 2010 Published on PsychCentral.com. All rights reserved.

About John M. Grohol, Psy.D.

Dr. John Grohol is the founder & CEO of Psych Central. He is an author, researcher and expert in mental health online, and has been writing about online behavior, mental health and psychology issues -- as well as the intersection of technology and human behavior -- since 1992. Dr. Grohol sits on the editorial board of the journal Computers in Human Behavior and is a founding board member and treasurer of the Society for Participatory Medicine.